Many neurological disorders cause severe disabilities and limit a person's options for independent operation of technology. Brain computer interfaces (BCIs) can enable people with complete paralysis to control assistive devices independently. People with amyotrophic lateral sclerosis (ALS) are uniquely suited to participate in the development of clinical applications of BCIs because they can often benefit from the limited capabilities offered by current BCIs. People with ALS routinely receive power wheelchairs that have powered systems for repositioning and pressure relief, such as tilt-in-space. Unfortunately, with ALS progression, the controls for these tilt/recline systems often become inaccessible to people with ALS, increasing their discomfort and dependence on attendant care. BCIs have the potential to provide such people with independent control of power tilt/recline for pressure relief, comfort, and improved respiration. This experimental/development grant (R21) application will support the prototype development of a BCI to control tilt/recline along with initial testing by subjects with ALS. The proposed work will address the overall research question: "How well can subjects with ALS use a BCI based on the P300 response in electroencephalogram (EEG) to operate a power wheelchair tilt/recline system in their home environments?" Project hypotheses include: 1. A BCI based on the NIH-funded BCI2000 can replace standard controls to adjust a wheelchair tilt/recline system. 2. People with ALS will find a BCI that provides independent control of wheelchair tilt/recline sufficiently useful so that they will use the system in their homes an average of at least 10 hours per week. The proposed work will include the development of a BCI based on the brain's P300 response to the oddball paradigm to replace the standard controls found on power wheelchair tilt/recline systems. Over the course of the proposed work, the BCI will be tested for many months in the home environment by at least 6 subjects with ALS. A telemonitoring system will be installed in subjects'homes for technical support. Subjects'skills and perceptions will be measured on a regular basis to obtain objective and subjective measures of BCI utility. Subjects'levels of impairment will also be measured regularly to use in the evaluation of the BCI over the course of disease progression. This relatively long-term use of BCIs by people with ALS to operate a tilt/recline system in a home environment will be a significant test of BCI utility and the information gathered will guide future BCI development. Along with the innovations in BCI design required for successful use in the home environment, the collection of preliminary data on usage, utility, ability and impairment, and the trends and correlations that this data reveal should lay the groundwork for future studies involving larger numbers of subjects. Overall, this will bring BCIs closer to becoming a clinically available option for people with a variety of severe disabilities. PUBLIC HEALTH RELEVANCE: Brain Computer Interfaces (BCIs) are a new technology that could provide people with complete paralysis with the ability to operate assistive devices independently. The proposed work will test a BCI as a clinical management tool for people with amyotrophic lateral sclerosis (ALS, aka Lou Gehrig's Disease) to independently adjust tilt/recline for comfort and improved respiration in their home environments. By examining the realistic effort/benefit trade-offs the subjects'experience while using a BCI, the proposed work will lay a foundation for the clinical use of BCIs by people with physical impairments resulting from a variety of diseases and injuries, such as ALS, muscular dystrophy, spinal cord injury, and brainstem stroke, and it will inform the further development of BCIs into practical clinical tools.